MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY – OIL, GAS, AND MINERALS DIVISION

SOIL EROSION & SEDIMENTATION
CONTROL PLAN / 1. Name and address of applicant
Part 615 Oil/Gas Well Part 625 Mineral Well / Phone: ( ) Fax: ( )
2. Well or project name: / 3. Well or project location:
Section(s) T R
4. Name and address of County or local Enforcement Agent (CEA) / 5. Township / 6. County
7. Date earth changes expected to start
8. Date of expected completion
Phone: ( ) Fax: ( )
9. Name and address of person responsible for earth change: / 10. Name and address of person responsible for maintenance:
Phone: ( ) Fax: ( ) / Phone: ( ) Fax: ( )
11. Send copies of supplemental plat required by Part 615, R 324.201(2)(b) or R 324.504(4), and this form and all attachments, to CEA. For Part 625 Mineral Wells, send to CEA only as instructed by OGMD staff.
Date sent to CEA
EARTH CHANGE ACTIVITIES
12. Project description: (Project activities may be permitted sequentially.)
a. Number of well sites , acres / d. Flow line(s) trenched in off well site* feet, acres
b. Number of surface facility sites , acres / e. Flow line(s) plowed in off well site* feet, acres
c. New access roads feet, acres / *Contact CEA for fee schedule
13. Describe sites for which permits are being sought under Part 301 (Inland Lakes & Streams)
Describe sites for which permits are being sought under Part 303 (Wetlands) .
List file numbers if known .
14. Attach detail map at scale of 1”=200’ or larger, with contour lines at a minimum of 20’ intervals OR percent slope descriptions.
15. Areas requiring control structures
Will earth changes occur in areas with slopes of 10% or greater; areas where runoff water is likely, such as runs greater than 500’ of moderate slope (5% to 10%), narrow valley bottoms, etc.; areas within 500’ of a lake or stream; or other areas where sedimentation to a wetland or drainage way may occur? Yes No
Indicate any of the following erosion control structures that will be utilized. Identify location on detail map and attach detail plan.
Indicate on plan whether erosion control structures are temporary or permanent.
.Diversions Culverts .Sediment basins Silt fences Rip-rap .Berms .Check dams
.Other ______
16. Site restoration
.Topsoil will be segregated from subsoil and stockpiled OR No topsoil on site
.Recontour and revegetate as soon as weather permits. Seed mix
Describe other proposed methods of restoration
17. Application prepared by (name) Signature Date
FOR USE OF COUNTY OR LOCAL ENFORCING AGENT
INSTRUCTIONS TO COUNTY OR LOCAL ENFORCMENT AGENT: Copies of supplemental plat required by Part 615, R324.201(2)(b) or R324.504(4), and this form and all attachments are provided for CEA review and informational purposes only. For activities issued under Part 615, local permitting for SESC is not necessary; OGMD staff will evaluate and enforce SESC measures (SEE R324.9115 (3) of Part 91, Soil Erosion and Sedimentation Control, NREPA, PA 451 of 1994). Submittal to CEA is not a requirement under Part 615 or 625. Part 615 and 625 Permits to Drill and Operate include erosion control plan approval for well sites, access roads, flow lines, and surface facilities. Return this form to the applicable field or district office of the Oil, Gas, and Minerals Division (OGMD) within 30 days of receipt. OGMD will consider all comments and recommendations in reviewing the application.
17. Comments
Conducted on-site inspection Date______Inspected site with representative of applicant Date______
CEA (name) Date

EQP 7200-18 (rev. 2/2017) Enclose with Application For Permit To Drill